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Why most doctors don’t know that much about marijuana

Dr. Nina Robb learned about the effects of alcohol intoxication when she was in medical school. She also learned about alcohol-induced liver disease. She learned about heroin overdose and how methamphetamine affects the human body.

When it came to marijuana, she never heard one word good or bad about the plant at medical school. I'm guessing now that the reason is there was nothing bad to say about marijuana and body toxicity.

"On the other hand, they didn't teach us about nutrition either," Robb says, pointing out that there may have been other gaps in medical education.

Robb, who recently opened Integrity Medicine in Southfield, has been filling in the gaps in the years since she was in medical school. And she knows a lot more about medical marijuana. The IMG is a medical marijuana certification clinic, but Robb brings a lot more to the table than simply certifying that patients can get marijuana.

"I've always had an interest in herbal medicine as an adjunct to treatment in a variety of medical ailments," Robb says. "I've been interested in that all my life. I've read a number of books on herbal medicines and cannabis is in those books."

She's also taken the course New York doctors are required to take if they are going to recommend marijuana to their patients. It's only a four-hour class, but it's more than Michigan doctors are required to take. The IMG Facebook page provides links to articles about medical marijuana. The sources are as varied as a Rolling Stone piece on Whoopi Goldberg-branded cannabis products for menstrual cramps, a study on PubMed (a website for medical literature) showing a positive relationship between cannabis use and surviving a traumatic brain injury, and a 158-page document from Health Canada on the use of cannabis and cannabinoids for medical purposes.

The Canadian document is particularly thorough, starting with the endocannabinoid system that "is an ancient, evolutionarily conserved, and ubiquitous lipid signaling system found in all vertebrates, and which appears to have important regulatory functions throughout the human body."

The list of physiological processes it affects is too long to list here, but it actually begs the question: What doesn't it affect?

However, it also begs the question of how to use it for different health issues, and in ways people are comfortable with. That's something Robb hopes to help patients work through.

"I started Integrity Medicine Group because I wanted to provide a clinic where patients would not just get a medical card, but counsel in the appropriate and safe use of cannabis," says Robb. "Cannabis use has to be personalized, it's not a one size fits all. Some patients would benefit more from vaporizing than smoking. A migraine patient during an acute migraine may not be able to take an edible."

When it comes to using medical cannabis, you might rub it on your joints, or rub it on your skin. You might take it as a highly concentrated, powerful cancer fighting agent known as Rick Simpson Oil, or as a less potent extract or infusion in numerous skin and beauty products. Some people want CBD products without the high-inducing THC. Some don't want to smoke and prefer infused chocolate bars, cookies, suckers, and gummy candies. Hey, they even got a suppository. It was invented by the guy who grows the official U.S. pot at the University of Mississippi. He claims it's the most efficient way to ingest marijuana.

The point is that a lot of people who have no experience with marijuana need some help figuring out what's what. Even if they had experience with it a long time ago there can be a bewildering array of strains of bud — sativas, indicas, hybrids, high THC, high CBD. And then there are different ways of ingesting — let alone all the products available for ingesting them.

Robb seeks to help patients find the most effective and appropriate method.

"Different proportions of CBD and THC are appropriate for different conditions," she says. "Some people find the THC unpleasant, some have anxiety and panic attacks. Some patients don't want THC, they desire pain relief of muscle spasms without the psychological effect. Other patients benefit from higher proportions of THC."

Like most medications, doctors and patients need to work together to find the right levels of medication to be effective. However, most doctors don't know that much about marijuana. Even if they are open to its possibilities, unless they pursue the information they just don't have the background.

"There are a lot of research articles posted on the National Institute of Health website," Robb says. "That's from our federal government [that has] been stonewalling this so much, but there is this on the website that implies that there are a lot of medical uses for marijuana. There is a lot of research from Europe and Canada that can be found, but you have to seek it out."

Yes, while our government diddles around trying to decide (despite the scientific findings it posts) if marijuana has medical uses, much of the rest of the world has moved well beyond that. Scientists in countries unencumbered by government second-guessing such as Israel, Spain, Italy, Australia, England, and elsewhere are making advances in treatments that make a difference for patients.

In the U.S., some doctors are coming around, but they still don't know much and are reluctant to openly endorse marijuana.

"I've been doing this since 2013," says Robb. "I've definitely seen a transformation among doctors. Few were referring their patients to marijuana, but with the publicizing of the opioid epidemic they want to reduce or eliminate use, I've seen more doctors referring patients. They have trepidations and don't want to be out in the open approving it. I get patients who say [their] doctor won't sign off on it, but they say, 'Why don't you try marijuana?' There is definitely more acceptance."

Acceptance. That's a nice word applied to this arena. Marijuana is a great medicine for some people. We just need to get enough people to accept that.

The Michigan Medical Marijuana Licensing Board is having a difficult time accepting that patients shouldn't have disruption in the delivery of their medication. At a recent meeting, the board discussed shutting down all dispensaries in the state and then having them apply for licenses under the new regulatory framework. One member wanted that shutdown to happen as soon as Sept. 5, although the new regulations aren't scheduled to be rolled out until November. It sounds like somebody doesn't understand that patients need their medicine.

As this gets worked out the Bureau of Medical Marijuana Regulation is creating five working groups — grower, processor, safety compliance facility, provisioning center, and secure transporter — to come up with regulations regarding different aspects of the industry. Those interested in participating should send their name, address, email, phone number, employer's name, subject area you are interested in, and a brief explanation detailing your qualifications to LARA-MedicalMarihuana@michigan.gov with the subject line "WORK GROUP." I know the anti-marijuana activists are working to get people on these work groups. The people who have a positive attitude toward marijuana need to get on board, too.